Test Code: 13845


Clinical Use

  • Detect and differentiate between type-1 and type-2 herpes simplex virus (HSV)
  • Assist in HSV diagnosis and patient counseling

Clinical Background

Herpes simplex virus infection is extremely common in the United States: about 68% of individuals over age 12 are seropositive for HSV-1, and more than 20% are seropositive for HSV-2. Type-specific diagnosis has important implications for prognosis and patient counseling. Although HSV-1 accounts for an increasing proportion of primary genital herpes, it is far less likely than HSV-2 to cause recurrent genital lesions. HSV-2 seropositivity, on the other hand, suggests a stronger likelihood of recurrent genital outbreaks and viral shedding, even when asymptomatic. Individuals who are seronegative for HSV-1 and/or HSV-2 are at risk for acquiring infection from seropositive partners; seronegative women who become infected with either HSV-1 or HSV-2 during pregnancy are the most likely group of HSV-infected patients to pass on the virus to their neonate. Women who are seropositive for both types early in pregnancy have a lower likelihood of neonatal transmission than do women who have a first-episode outbreak later in pregnancy, but a greater likelihood of transmission than women who remain uninfected throughout pregnancy.

Culture is the preferred virologic method for diagnosis, but has low sensitivity when performed on samples from healing or recurrent lesions. Because IgG antibodies to HSV persist for life, serologic assays can detect infection even in the absence of lesions. Most HSV serology assays, however, are not type-specific. The HerpeSelect IgG assays distinguish between HSV-1 and HSV-2 on the basis of differences in the patient’s immune response to HSV glycoprotein G (gG).


Specimen Requirements

  • 1 mL refrigerated serum from a plain red-top tube (0.2 mL minimum).

CPT Codes*

86695 (HSV-1); 86696 (HSV-2)


Method

This enzyme immunoassay detects and differentiates between HSV-1 and HSV-2. Results are reported for each HSV type.


Reference Ranges

Herpes Ab Type 1, IgG:
            <0.90         Negative        
            0.90-1.10    Equivocal
            >1.10         Positive

Herpes Ab Type 2, IgG:
            <0.90         Negative  
            0.90-1.10    Equivocal
            >1.10         Positive


Interpretive Information

These assays are highly sensitive (91-100%) and specific (93 – 100%) for HSV-1 and HSV-2 infection, even in the absence of symptoms. Because antibodies may take several weeks to reach detectable levels after primary infection, negative results should be confirmed by repeat testing 4 to 6 weeks later in cases of suspected early infection. Thus, a negative result suggests absence of infection. A positive result strongly suggests infection.

*The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed.

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